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Preemies
Pedi just freaked me out RE: Iron levels
Let me preface this by saying that I am going to switch pedis, but until I can get in to see another one at the end of the month I'm stuck. I went in today with Annie to get her second Hep B shot and to follow up on the blood draw she had to check her iron levels on Friday. I don't really understand why she is on an iron supplement in the first place - I tried to ask him that at our last appointment and his response was "well its a good idea". And its my fault for not pushing it or researching it further when i got home, but I was just sort of stunned by his response and I felt stupid for asking another question. Fast forward to today and he said her 'cryt count has gone down' so he wants to do a repeat blood draw in a couple weeks. When I asked what that meant he said that it is to be expected in preemies and shes fine now but if it gets too low then her heart rate can increase and she won't feed as well and if it gets really low she can go into heart failure!!!!! WTF?!?!?!?!?!? So I asked if we should increase her dosage since shes gained almost 3 lbs since she first started it and he said no. Now I'm just terrified. Can anyone shed some light for me on Iron levels and preemies??
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Re: Pedi just freaked me out RE: Iron levels
I do not have a preemie but I have dangerously low iron and so I was concerned about my daughter. She was on an iron supplement as an infant because I was breastfeeding. Breastfed babies generally do not get enough iron.
The iron is what the body uses to make red blood cells. The red blood cells are the ones that carry oxygen throughout the body. So, if they are low, the heart has to beat faster to move the same amount of oxygen throughout the body. The decrease in oxygen would also make them sleepy. In the NICU, babies are often given iron and erythropoetin shots if their hematocrit (the crit level as your pedi said, aka red blood cell count) is low. With all this said, please don't think that your baby isn't getting enough oxygen....the blood just has to circulate through the body more to deliver the same amount.
Now, your pedi might be reluctant to increase the iron doseage, because too much iron can also be bad for LO's. It can cause constipation and very high levels can lead to toxicities.
I hope this helped clarify things for you. I wish I knew what the next step is for your LO, but other than epo shots and in extreme cases giving blood transfusions in the NICU, I don't know what else they do for LO's outside of the hospital.
First. If her crit level was low enough to cause heart failure then she would be getting a transfusion which quickly solves the problem.
To answer your question re the anemia- Babies are born with rbc from their mother passed through the placenta. RBC lack a nucleus so can not reproduce themselves so eventually they die. RBC are made in the bone marrow but this does not kick in until 6 months. So a term newborn is born with the rbc they will need until the marrow kicks in (about 6 months). Preemies are at a disadvantage because they have a longer timeline before their marrow kicks in and that they have less time to get maternal rbc through the placenta. It is normal for preemie rbc count (crit) to drop before it goes back up. In the nicu they look both at the number of mature rbc and the immature rbc. This is because if you transfuse it delays the marrow from kicking in (kind of a reverse feed back loop). So if the immature rbc count is trending up they are not as concerned. So your dr should be looking at both numbers. E was low for a while and ended up with a transfusion around her due date because her numbers were not trending up fast enough.
She went home on iron suplement (it was a supplement in addition to polyvisol) and her counts stabalized.
As for your pedi we love our family practitioner in Wellesley at the Marino Center if you are interested in going there I can pm her name. There are 4 family practitioners that see kids there and they are all great. A wonderful mix of both western traditional medicine and alternative treatments. They have a very different format of seeing patients than I have experienced at other offices and for each visit we sit in their office and talk for 20-30 min. before going to an exam room. They take lots of time with their patients and I never feel rushed.
Thank you for the responses! Very helpful info.
ssg73 - we have an appt with another pedi in the same building in cambridge. The location is so darn convenient for us. This practice was recommended by Sarah Schulman at the Brigham - she was in NICU D, not sure if you saw her. Looking forward to meeting someone else who is hopefully a little more supportive.
I'm very sorry that you're having to deal with this- I'm a veg and raising DD as one so we had her iron checked often too. I did want to dispel the above myth-- the iron found in breast milk is exponentially more easily absorbed than the iron in formula/cereal, etc, although on paper it numbers less. Understandably some preemies will absolutely need iron supplementation on top of this.
Here at https://www.kellymom.com/nutrition/vitamins/iron.html:
The iron in breastmilk is better absorbed than that from other sources. The vitamin C and high lactose levels in breastmilk aid in iron absorption.Iron SourcePercentage of Iron Absorbedbreastmilk~50 - 70%iron-fortified cow milk formula~3 - 12%iron-fortified soy formulaless than 1% - 7%iron-fortified cereals4 - 10%cow's milk~10%Note: The amount of iron absorbed from any food depends greatly upon the milk source of iron (eg, human vs cow), type of iron compound in the food, the body's need for iron, and the other foods eaten at the same meal.